Used For:

• Treatment of HIV-1 infection in adults and adolescents

Contraindications:

• Do not use in:Hypersensitivity to emtricitabine, tenofovir, or efavirenzSevere liver diseaseHistory of severe psychiatric illness (psychosis, suicidal ideation) – efavirenz riskPregnancy – 1st trimester (efavirenz is teratogenic)Concomitant use with certain drugs:St. John’s wortCertain anticonvulsants (e.g., carbamazepine, phenytoin)Rifampicin (dose adjustment required)

Side Effects:

• Common Side EffectsCentral Nervous System (Efavirenz-related)DizzinessDrowsinessVivid or abnormal dreamsInsomniaConfusion, anxietyGastrointestinalNausea, vomitingDiarrheaAbdominal painSkinRash (usually mild, appears in first 2–4 weeks)OthersFatigueHeadacheSerious (but Less Common) Side EffectsSevere depression or suicidal thoughtsSevere skin reactions (Stevens–Johnson syndrome)Liver toxicity (raised liver enzymes, hepatitis)Kidney toxicity (tenofovir-related)Bone mineral density loss (osteopenia/osteoporosis)Lactic acidosis (rare but life-threatening)

Precautions:

• Strict adherence is essential → missing doses can cause drug resistanceUse cautiously in:Patients with psychiatric disordersRenal impairment (monitor creatinine, eGFR)Hepatitis B or C co-infectionRegular monitoring:Viral loadCD4 countLiver and kidney functionAvoid stopping medication abruptly without medical adviceUse effective contraception during treatment (efavirenz reduces efficacy of some hormonal contraceptives)

Dietary Restrictions:

• Take on an empty stomach (high-fat meals increase efavirenz side effects)Avoid alcohol – increases liver toxicity and CNS effectsAvoid grapefruit and St. John’s wortMaintain adequate calcium and vitamin D intake (bone health)Stay well hydrated (kidney protection)Balanced diet to support immunity